From the Guidelines
For a patient experiencing lower extremity edema on amlodipine, an alternative antihypertensive medication such as an ACE inhibitor (like lisinopril 10-40 mg daily) or an ARB (such as losartan 50-100 mg daily) can be given, as these classes of medications are not typically associated with peripheral edema as a side effect, according to the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1.
Alternative Medication Options
When considering alternative medications, the following options can be taken into account:
- ACE inhibitors: These are a good option for patients with diabetes or kidney disease, and can help reduce the risk of cardiovascular events 1.
- ARBs: These are also a good option for patients with diabetes or kidney disease, and can help reduce the risk of cardiovascular events 1.
- Thiazide diuretics: These can be used as an alternative, but may not be as effective in patients with significant kidney disease 1.
- Beta-blockers: These can be used as an alternative, but may not be as effective in patients with certain comorbidities, such as asthma or peripheral artery disease 1.
Monitoring and Follow-up
When switching medications, it is essential to:
- Continue amlodipine until the new medication takes effect, typically 1-2 weeks.
- Monitor blood pressure closely during the transition.
- Check kidney function and electrolytes within 1-2 weeks if switching to an ACE inhibitor, ARB, or diuretic 1.
Specific Considerations
The specific choice of alternative medication depends on the patient's comorbidities, such as:
- Diabetes or kidney disease: ACE inhibitors or ARBs are preferred.
- Coronary artery disease or heart failure: Beta-blockers may be preferred.
- Asthma or peripheral artery disease: Alternative medications may need to be considered 1.
From the Research
Alternative Medications for Amlodipine-Induced Lower Extremity Edema
- The patient experiencing lower extremity edema on amlodipine can be considered for alternative medications, including:
- Lercanidipine or lacidipine, which are associated with less vasodilatory edema than amlodipine and nifedipine 2
- (S)-amlodipine, which has been shown to have a lower incidence of leg edema compared to conventional amlodipine 3
- Verapamil or diltiazem, which can be considered as an alternative to amlodipine 4
- Combination therapy with an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB) can also be effective in reducing edema 5, 2, 6
- Reducing the dosage of amlodipine or switching to a lower dose can also be considered to minimize edema 4
Mechanisms and Strategies for Reducing Edema
- Vasodilatory edema is a common side effect of antihypertensive therapy with vasodilators, including calcium channel blockers 2
- The addition of an ACEI or ARB to a dihydropyridine calcium antagonist can significantly reduce vasodilatory edema 2
- Diuretics are usually not effective in alleviating pedal edema 4, 6
- Non-pharmacologic actions or observation may be considered when the edemas are mild and not bothersome 4